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Abstract

We thank Drs Gkolfakis, Tziatzios, and Triantafyllou1Gkolfakis P. Tziatzios G. Triantafyllou K. Oldie but goodie? Do attending endoscopists really need their fellows?.Gastrointest Endosc. 2019; 89: 446Abstract Full Text Full Text PDF Scopus (2) Google Scholar for their interest and their thoughtful comments on our study.2Bitar H. Zia H. Bashir M. et al.Impact of fellowship training level on colonoscopy quality and efficiency metrics.Gastrointest Endosc. 2018; 88: 378-387Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar A retrospective analysis of their colonoscopy cohort yielded similar results as to the lack of difference in the adenoma detection rate (ADR) between procedures involving trainees and those performed by attendings only. We agree with their conclusion that involvement by fellows should cause no worsening in ADR. Effectively, similar ADRs attest to an adequate training environment under proper supervision by attendings. However, a highlight of our study was the drastic improvement in the adenoma management efficiency index at higher levels of training. The ADR did not differ by training year, but the efficiency metric did; therefore, ADR is not a good discriminator of skill acquisition in training, whereas the efficiency metric may be. This pins time to procedure completion as another major attribute of trainee involvement. One study reported an increase in average procedure time of 5 to 16 minutes per colonoscopy compared with private settings,3McCashland T. Brand R. Lyden E. et al.The time and financial impact of training fellows in endoscopy. CORI Research Project. Clinical Outcomes Research Initiative.Am J Gastroenterol. 2000; 95: 3129-3132Crossref PubMed Google Scholar which translates into a significant financial burden. Thus, for the purpose of training the gastroenterologist of the future, time-effective and cost-effective options are needed to align colonoscopy quality and training requirements with financial goals of training institutions at a time of shrinking reimbursement. GI endoscopy simulation training may be such an option whereby the basics of colonoscopy are learned in a more efficient setting and deferring more advanced skill set learning to the clinical arena under the guidance of the “oldie and goodie” well-experienced endoscopist. Although studies support its efficacy for improving clinical endoscopy skills of novice trainees,4Singh S. Sedlack R.E. Cook D.A. Effects of simulation-based training in gastrointestinal endoscopy: a systematic review and meta-analysis.Clin Gastroenterol Hepatol. 2014; 12: 1611-1623.e4Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar the optimal application of such a technique in a colonoscopy training curriculum is evolving.5Grover S.C. Scaffidi M.A. Khan R. et al.Progressive learning in endoscopy simulation training improves clinical performance: a blinded randomized trial.Gastrointest Endosc. 2017; 86: 881-889Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar All authors disclosed no financial relationships relevant to this publication. Oldie but goodie? Do attending endoscopists really need their fellows?Gastrointestinal EndoscopyVol. 89Issue 2PreviewIn their retrospective study of more than 2000 colonoscopies, Bitar et al1 showed that adenoma detection rate (ADR) was not increased by the participation of fellows during colonoscopy. This finding prompted us to review our past 2 consecutive years of colonoscopy data of 2241 screening, surveillance, and diagnostic examinations (1580; 70.5% fellow-involved), inflammatory bowel disease evaluation and obstruction cases excluded. ADR, mean adenoma per colonoscopy, and examination completion rate were not different between the fellow-involved and the attending endoscopist-only groups (27.8% vs 26.1%, 0.45 ± 0.93 vs 0.44 ± 0.98 and 95.3% vs 94.6% [P = .51], respectively). Full-Text PDF